Section 2 - Child health checks

Health check recommendations

• Femoral pulses in all children at each child health check to 6 months of age
• Breathing and heart sounds at each child health check to < 5 years of age
• Haemoglobin in all Aboriginal and Torres Strait Islander children at 6, 9 and 18 months of age, then at 10–15 years for girls

1. Procedure

• Undertake the measurement and ask the questions as per Table 1.
• Be prepared to explore and clarify answers
• Identify measurements outside normal limits
• Provide brief intervention and resources
• If a child requires follow-up place on a recall register and refer as necessary

1. Breathing
   • Observe the chest rise and fall. Record how many breaths are taken in 1 minute
   • A suitably trained clinician will auscultate lung fields for breathing sounds
2. Femoral pulses
   • Position the child on their back (supine) with their groin (inguinal) area exposed
   • Flex the hips and gently abduct the legs
   • Place the tips of 2 or 3 fingers along the inguinal ligament midway between the iliac crest and the pubic symphysis
   • Palpate both left and right femoral pulses simultaneously to ensure they are symmetrical, strong and equal
   • May take time to identify pulse while repositioning fingers
   • If unable to palpate, refer to another clinician to assess
3. Heart sounds
   • A suitably trained clinician will auscultate heart sounds. See Resource 1.
4. Haemoglobin (Hb)
   • Refer to the haemoglobinometer or point-of-care product instructions for instrument use and calibration. Ensure cartridges are within date

2. Results

1. Breathing ^1,2
   • Undertaken to identify exposure to environmental irritants (e.g. tobacco smoke, fires and dust), infections or other abnormalities to prevent future chronic chest conditions
   • See Table 2. for respiratory rates for healthy children
   • A child should not get breathless at rest, after short walks or waking at night
   • Recovery from breathlessness should be quick after running or playing
   • Breath sounds should be free of coughs, wheeze, crackles, rhonchi, rales etc

2. Femoral pulses
   • Undertaken to assess arterial blood flow to the legs. Insufficient flow may indicate narrowing of the aorta (aortic coarctation); a birth defect
   • Both pulses should be symmetrical, strong and equal; not weak, unequal or absent
3. Heart sounds ³
   • Undertaken to assess heart valve function and anatomical defects e.g. Rheumatic heart disease especially in Aboriginal and Torres Strait Islander children
   • Heart sounds should be free of murmurs, gallops, clicks or other abnormal sounds
4. Haemoglobin ^4,5
   • Measured to identify anaemia associated with Developmental delay or disability (child) in:
     • Aboriginal and Torres Strait Islander children
     • those aged 6–30 months
     • low birth weight and premature infants
     • babies weaned to poor diets
     • adolescent girls at puberty due to menses
   • See Table 3. for haemoglobin levels
   • Clinical signs of low haemoglobin include:
     • pallor
     • heart murmurs
     • lethargy
     • failure to thrive
     • signs of cardiac failure
     • weakness
     • shortness of breath

3. Brief intervention

1. Haemoglobin ^4,5
   • Provide Diet and nutrition information. Encourage foods that are iron rich or improve iron absorption:
     • breastfeeding exclusively to 6 months (or longer) or age appropriate infant formula
     • red bush meat, beef, lamb, liver or kidneys
     • chicken, fish, egg yolks
     • iron fortified baby cereal
     • citrus fruit or juice
     • apricots, prunes, green vegetables, spinach, silverbeet, broccoli
     • lentils, beans, grains, whole wheat, brown rice, nuts (children > 2 years)
   • Provide information of foods that are iron poor or inhibit iron absorption:
     • cow’s milk < 1 year of age
     • > 500ml/day of cow’s, soy, coconut, goats or powdered milks > 1 years of age
     • tea, coffee, colas
     • processed and high sugar foods or drinks
2. Breathing ^1,2
   • Provide Table 4. information to parents about triggers for breathing problems